Healthcare Provider Details

I. General information

NPI: 1003814930
Provider Name (Legal Business Name): R JANE WILLIAMS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BAHNSON HALL (MTS) 1200 MAIN ST.
BETHELEHEM PA
18018-6614
US

IV. Provider business mailing address

1670 LINDBERG ST
BETHLEHEM PA
18020-6452
US

V. Phone/Fax

Practice location:
  • Phone: 484-226-5073
  • Fax:
Mailing address:
  • Phone: 484-226-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPA-008219-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS-008219-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: